By Mark Tyndall MD ScD FRCPC
Expert Advisor on Harm Reduction to the Vaping Industry Trade Association (VITA)
It would be difficult to find a smoker who did not believe that smoking cigarettes was bad for their health. In fact, it is estimated that on any given day over 70% of smokers would like to quit and most have tried multiple times without success. It would also be difficult to find anyone in the medical profession who does not understand the grave health consequences of smoking cigarettes. Smoking is associated with so many poor health outcomes that it would be tough to come up with a comprehensive list. Cigarettes are directly and biologically linked to lung cancer, chronic obstructive pulmonary disease (COPD), heart disease, stroke and peripheral vascular disease. In addition, there are many other cancers, metabolic diseases, and chronic ailments that are made worse by smoking.
As a society we should do everything that we can to reduce exposure to cigarettes and help people to stop. We know that this would have massive positive implications for our health care system and would immediately result in a healthier population. Unfortunately, from a public health perspective, we have decided to ride this one out by accepting the status quo and focusing our efforts on primary prevention – trying to prevent the next generation of young people from smoking. We applaud ourselves as we promote national graphs that show a slow decline in overall smoking prevalence from year to year, but fail to point out that this is mainly driven by the premature and preventable death of people who smoke and that the death rates are highest in society’s most disadvantaged groups. We have promoted the false idea that the only successful outcome for a smoker is abstinence from both cigarette smoking and nicotine use. If you are unwilling or unsuccessful in your quest for abstinence, then there is nothing much to offer. But there is!
Vaping is the best chance that we have ever had to make cigarette smoking history. Here is a technology that delivers nicotine in a way that is satisfying to most smokers but with a small fraction of the health risk compared to smoking. There should be absolutely no controversy around the fact that vaping is safer than smoking cigarettes. Vaping eliminates the exposure to essentially all of the 7000 chemicals that have been identified from burning tobacco including the toxins and carcinogens that are directly linked to disease. The toxins that are detected occur at a small fraction of the levels found in cigarettes.
One of the most fascinating and tragic aspects around vaping is the lack of buy-in from smokers themselves. While some of the most compelling and committed advocates for vaping are ex-smokers who have had their lives changed through vaping, they have been drowned out by the relentless stream of anti-vaping propaganda and misinformation. In Canada we have chosen to put all of the focus on preventing youth access to vaping products and we have been willing to ignore and undermine the major benefits that vaping would have for current smokers.
Recently, Health Canada released findings from a series of focus groups designed to inform a new set of Health Information Messages (HIM) for smokers. These messages are designed to be put directly on or inside of cigarette packages. The fifteen in-person focus groups were conducted in five Canadian cities between July 13th and July 27th, 2019 and included 132 participants who were regular cigarette smokers. While the main goal of the exercise was to collect information around the potential impact of the messaging – what would people find most engaging and helpful – the comments around vaping provided a brief snap-shot into how smokers view vaping. Five main themes emerged from the report.
The first was that smokers felt that they would be trading “one addiction for another addiction” if they switched to vaping. This is a serious misconception and one that has been pushed by anti-vaping advocates who purposely blur the lines between nicotine addiction and smoking cigarettes. The whole point of vaping is to provide a safer option for those who continue to use nicotine. Vaping is beneficial because it greatly reduces health risks associated with cigarette smoking – not because it “cures” nicotine addiction.
The second theme is around safety with concerns that vaping devices are dangerous. In 2019, it was reported that a 24-year-old man from Texas had a vape pen explode in his mouth and he died. This generated international media attention and outrageous claims around the dangers associated with vaping devices. While regulations are certainly needed to ensure that the devices meet safety standards, the risk is extremely small. Cigarettes require an actual open flame to light them up and are a leading cause of house fires, forest fires, and childhood burns. In comparison to these cigarette smoking risks, vaping provides a far safer option and should be promoted as such.
The third theme is around exposure to unknown harmful chemicals that are released by vaping. People who smoke appear to be uninformed about the major differences in both the quantity of toxins and the concentration of the toxins released by cigarettes and vaping products. In fact, this is the whole reason to vape – to reduce exposure to deadly toxins and carcinogens. People have clearly not been provided the information that they require to make reasonable decisions.
The fourth theme is that “the jury is still out” on the long-term health impact of vaping. This is a common argument that has been put forward by many anti-vaping groups. It is true that there are no long-term prospective studies yet on the health impact of vaping. This must be a priority for the research community. However, there has been nearly a decade of widespread nicotine vaping and no specific illnesses have emerged. We do know with certainty the long-term adverse health impact of smoking cigarettes and there is absolutely no reason to think that vaping will come close.
The fifth theme was that it was inappropriate and confusing for Health Canada to “promote” vaping as an alternative to cigarette smoking when they also say that vaping can be harmful. This is the great challenge around messaging for harm reduction in general: that convincing people if they are unable to eliminate an inherently risky behavior, then at least it should be done as safely as possible. Health Canada and public health agencies need to be clear that if you are a current smoker, vaping is a much safer option.
The role of public health is to promote policies and regulations that optimize health for everyone. This must include the five million Canadian smokers who would benefit from switching to vaping. Somehow, through misguided public health messaging, a rejection of harm reduction as it applies to tobacco, and a media that has created moral panic, we have severely undermined the great potential that vaping has to offer. The clear losers in all of this are the cigarette smokers who have been left confused and unaware of the benefits that they could experience through vaping. People have the right to accurate information, people have the right to a safer product, and people have the right to better health.